Civil society leadership in the struggle for AIDS treatment in South Africa and Uganda

Includes abstract.Includes bibliographical references.This thesis is an attempt to theorise and operationalise empirically the notion of ‘civil society leadership’ in Sub-Saharan Africa. ‘AIDS leadership,’ which is associated with the intergovernmental institutions charged with coordinating the global response to HIV/AIDS, is both under-theorised and highly context-specific. In this study I therefore opt for an inclusive framework that draws on a range of approaches, including the literature on ‘leadership’, institutions, social movements and the ‘network’ perspective on civil society mobilisation. This framework is employed in rich and detailed empirical descriptions (‘thick description’) of civil society mobilisation around AIDS, including contentious AIDS activism, in the key case studies of South Africa and Uganda. South Africa and Uganda are widely considered key examples of poor and good leadership (from national political leaders) respectively, while the Treatment Action Campaign (TAC) and The AIDS Support Organisation (TASO) are both seen as highly effective civil society movements. These descriptions emphasise ‘transnational networks of influence’ in which civil society leaders participated (and at times actively constructed) in order to mobilise both symbolic and material resources aimed at exerting influence at the transnational, national and local levels

Civil society and the state in Uganda’s AIDS response

This paper investigates state-civil society relations in the Ugandan AIDS response through a critical exploration of the history of Uganda’s ‘multi-sectoral’ and ‘partnership’ approaches, particularly as it pertains to The AIDS Support Organisation (TASO). It finds that the Ugandan government’s reputation for successful prevention campaigns is not necessarily deserved, and that the effectiveness of civil society is limited by an authoritarian political culture. Despite these limitations, however, state-civil society partnership did contribute to the emergence of a relatively effective coalition for action against HIV/AIDS. Donors were essential in encouraging the emergence of this coalition, but have also inadvertently undermined the emergence of strong and independent civil society voices able to hold the Ugandan state accountable

The challenge of defining standards of prevention in HIV prevention trials.

As new HIV prevention tools are developed, researchers face a number of ethical and logistic questions about how and when to include novel HIV prevention strategies and tools in the standard prevention package of ongoing and future HIV prevention trials. Current Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) guidance recommends that participants in prevention trials receive 'access to all state of the art HIV risk reduction methods', and that decisions about adding new tools to the prevention package be made in consultation with 'all relevant stakeholders'. The guidance, however, leaves open questions of both process and implementation. In March 2009, the Global Campaign for Microbicides, UNAIDS and the Centers for Disease Control and Prevention convened a consultation to develop practical answers to these questions. Fifty-nine diverse participants, including researchers, ethicists, advocates and policymakers, worked to develop consensus criteria on when to include new HIV prevention tools in future trials. Participants developed a set of questions to guide decision-making, including: whether the method has been recommended by international bodies or adopted at a national level; the size of the effect and weight of the evidence; relevance to the trial population; whether the tool has been approved or introduced in the trial country; whether adding the tool might lead to trial futility; outstanding safety issues and status of the trial. Further work is needed to develop, implement and evaluate approaches to facilitate meaningful stakeholder participation in this deliberative process

The Power of the Weak: How Informal Power-Sharing Shapes the Work of the UN Security Council

To what extent is the work of international organizations shaped by their most powerful members? Can minor powers influence the decisions taken by these organizations? This dissertation presents the argument that great powers engage in power-sharing in order to attain unanimity inside international organizations, which enhances compliance and increases the effect of the signals these organizations convey to the public. The pursuit of unanimity lends weight even to votes that are not needed for the adoption of a proposal under the formal rules. It enables minor powers to exert more influence inside international organizations than they could if the formal rules and/or the balance of material power between member states determined the outcome of decision-making in international organizations. An analysis of the UN Security Council tests this argument. The dissertation identifies a series of informal power-sharing practices in the Security Council, which systematically depart from the organization's formal rules, and which promote consensus and augment minor powers' influence far beyond what one would expect on the basis of the material capabilities and voting power of these states. In turn, these informal power-sharing practices are motivated by great powers' desire to attain unanimous support for the policies enacted in the Security Council, irrespective of the body's formal voting rules. Survey experiments demonstrate the rationale behind great powers' pursuit of unanimity. They show that a policy's endorsement by a united Security Council has a much larger signaling effect on public opinion than the policy's approval by a divided Council. Qualitative case studies and novel design-based causal inference that exploits natural experiments show that minor powers strongly influence the deployment of UN peace operations and UN counter-terrorism sanctions, and that minor powers also use their influence in the Council to attain side-payments. Minor powers' influence is particularly strong during crises, when great powers are most eager to secure small states' votes through power-sharing. Interviews with diplomats in seven countries and quantitative analyses of exogenous variation in minor powers' representation on the Security Council under pre-determined rotation rules trace minor powers' influence to informal power-sharing practices in the Council